Release Form Mission Street Tattoo

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Birthdate

I acknowledge by signing this release form that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from Mission Street Tattoo. I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that the procedure has been described to me, and I have been advised of the facts and matters set forth below, and I agree as follows. Read, check all boxes, and sign.

I agree to release and forever discharge and forever hold harmless Mission Street Tattoo and its associates, agents officers and shareholders from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by Mission Street Tattoo and its associates, agents and representatives in the future.

I have been fully informed of the risks of tattooing including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all risks that may arise from tattooing.

Signature

Date

Please upload an image of your Drivers License, State Identification , or Passport

Release Form

Medical History